| NPI | 1447004270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW BLAKE HILLSTEAD Owner/Partner 801-900-4748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-04-17 |